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March 17, 2014

Q&A with Kate Grant: Helping Women with Fistulas

by Frances Alonzo

The stories are heartbreaking - pregnant women in remote rural areas in Asia enduring a long or often difficult labor, some losing their babies. The women are left with incontinence and leaking wastes from obstetric fistulas. Some husbands abandon their wives, while others try to find help, but the road is long and the women are often ostracized by their communities for these birth injuries. 
 
However, the Fistula Foundation is one of the groups that have been supporting women, telling every woman with a fistula that it is possible to be cured and to feel hopeful once again. VOA's Frances Alonzo spoke with Kate Grant, the CEO of the Fistula Foundation.

 
GRANT: It’s basically a hole between an internal organ and the outside world that shouldn’t exist. In this case, it’s holes in bladder, vaginas, sometimes rectum that leave a woman incontinent. So again, it’s a childbirth injury that occurs because women don’t have access to emergency obstetric care that leaves them incontinent. The good news is most of the time those fistulas can be sewn up by a trained surgeon and that woman can be given back continence and health.
 
ALONZO: How many women in Asia are affected by this?
 
GRANT: We don’t have exact numbers, Frances, and it’s not that we don’t want them. The W.H.O. doesn’t have them, the U.N. doesn’t have them, because this happens to women in usually the remotest part of developing countries. We don’t have a specific number, we have a global number of one million women that are affected, a proportion of those in Asia, the balance in sub-Saharan Africa.
 
ALONZO: Is there a social stigma to having a fistula?
 
GRANT:  There is incredible social stigma in having a fistula. And the reason is that women that have this are usually the poorest women in the poorest countries in the most remote areas. So trying to deal with incontinence if you are living in a remote rural area where you’ve got a dirt floor, that incontinence becomes something that makes your day-to-day very difficult to manage. And also because of a lack of understanding about what causes it, that it’s a birth injury rather than occurred for no fault of the woman. There can be belief systems that demonize that woman for the reason that she got this was something that she had done, something bad. And that she had gotten this injury as kind of a punishment. That’s not true either. 
 
ALONZO: Does it matter how old the mother is? Her age?
 
GRANT: Generally we see most fistulas happening on a first birth which means the woman is usually younger, late teens, early twenties. The earlier a woman has a child the more trouble you are going to have with fistula and with other birth injuries. So, yes, a teenage mother, one that is 13, 14, 15, where their pelvis is not yet fully developed, is more likely to get a fistula than an older mother. But, even older mothers get fistulas, it’s not just about age.
 
ALONZO: Can you tell me what Asian countries are making strides in helping women, and what are those countries that are lagging behind?
 
GRANT: Unfortunately, the same countries where we see high infant mortality rates, we see high maternal mortality rates. These things tend to go together. When the women die, the babies die too. The countries which lag behind and have still the highest maternal and infant mortality rates are Afghanistan, Pakistan, Cambodia and even Bangladesh, although Bangladesh has made some strides in recent years.
 
The countries that have done much better, obviously they are very developed Asian countries… like Japan, Singapore, South Korea has extremely low maternal mortality rates.
 
Some countries that are kind of in the middle that have made progress that have a ways to go would be Philippines, Vietnam, Thailand, even China. But those countries, the last four that I mentioned are definitely moving in the right direction [and] have rapidly dropping child and maternal mortality rates. And it’s that initial list that I gave you, the Afghanistan, Pakistan, where there is still a great deal of work to do.
 
ALONZO: What keeps you going? Is there something that fuels you to say, “I’m ready to face this again and I’m ready to help women with this issue?”
 
GRANT:  That’s a very good question about what’s important in continuing to progress. It’s easy. We have pictures all over our office of the women we have been able to help, the courageous doctors that we are funding to do this work. And we have in our conference room a huge map of the world where we have all of the sites where we are funding and a big graph on the wall that shows the number of surgeries we are able to fund every year has grown dramatically.

We’ve tripled the number of surgeries we are able to fund just in the last four years. And behind those numbers are women. Individual women. I’ve met them. I’ve met them in Bangladesh, I’ve met them in Pakistan. Women who’ve suffered like no woman should have to suffer simply for trying to bring a child into the world. 

Fistula is a tough concept because talking about incontinence, where you have to talk about it. If you want to understand it, you have to talk about feces and urine and vaginas and rectums. It’s a taboo subject. And one can understand this, one can understand this is not something pleasant to understand. The human impact is so profound that people shy away from it. So the more people come forward and say, “yeah, I’ll do my part” to broaden the circle of awareness about this problem, the more women we know we will be able to help.